Antibiotic resistance remains much higher in children who have been previously treated for H. pylori infection that highlights the importance of choosing the most appropriate treatment regime for the initial treatment for H. pylori infection, based on local antibiotic resistance patterns, if there are no facilities to perform culture and susceptibility testing for individual children. Clarithromycin resistance is much higher in children compared with that in adults [44,45,47]. In Tunisia, it was 25% in children compared with 18.8% in adults [43], while in Spain and Brazil, there was a twofold difference in the AZD6738 cell line resistance rate

between children and adults [44,48]. In the only study to look at the increase in resistance rates over time in children, Boyanova et al. [47] found that clarithromycin resistance is increasing quickly while metronidazole resistance

is remaining stable or is declining. It may not be the case everywhere, because in Finland for example, the macrolide consumption has declined and consequently clarithromycin resistance tested in adult strains was stable or declining [49]. The type of 23S rDNA mutation may also impact on the efficacy of the treatment [37]. While much has been achieved to date in our understanding of the complex host–pathogen relationship with H. pylori, there is an increasing awareness of Selumetinib cost the need to carry out research on virulence factors and host–pathogen interactions in children as this most adequately reflects the conditions required for colonization. An effective treatment for the management of H. pylori in children remains elusive. The authors have declared no conflicts of interest. “
“Recurrence of Helicobacter pylori (H. pylori) infection is the result of either recrudescence or reinfection. Annual recurrence rates per patient-year of follow-up have been reported to vary across countries. The aim of this study was to analyze recurrence rates of H. pylori

after first-line and second-line eradication therapies in Korea. From 2007 to 2010, 2691 patients Tacrolimus (FK506) with H. pylori infection received first-line therapy and 573 patients who failed to respond to first-line therapy received second-line therapy. H. pylori infection and the success of eradication were assessed by endoscopic biopsy and rapid urease test or 13C-urea breath test. All patients were advised to undergo 13C-urea breath test or esophagogastroduodenoscopy with biopsy or rapid urease test 6 months after eradication, with annual follow-up thereafter. The eradication rate of the first-line therapy was 79.9% (1283/1605) and that of the second-line therapy was 90.4% (394/436) by per protocol analysis. Annual recurrence rates sharply declined after 2-year follow-up. Annual recurrence rates within and after 2-year follow-up were 9.3 and 2.0% after first-line therapy and those of second-line therapy were 4.5 and 2.9%, respectively. Annual recurrence rates of H.